Module 3 Endocrine Exam With Correct Answers

What is hypothyroidism - Clinical state resulting from a reduction in the amount of circulating free thyroid hormone, or from resistance to the action of thyroid hormone. What is hyperthyroidism - Body's tissues are exposed to an increased level of circulating thyroid hormone ( T3 and T4) T3 and T4 are 99% protein bound and not active T3 more activity than T4 What is congenital hypothyroidism? - How is congenital hypothyroidism it treated? - What happens if congenital hypothyroidism it is not treated - What lab values would you expect to see with primary hypothyroidism - TSH elevated; T4 low; T3 normal What lab values would you expect to see with subclinical hypothyroidism - TSH elevated; T4 normal; T3 normal What lab values would you expect to see with primary hyperthyroidism - TSH decreased; T4 elevated; T3 normal What are the most common forms of hyper thyroid - Autoimmune Graves disease (hyperthyroidism) What are the most common forms of hypothyroidism - Autoimmune Hashimoto thyroiditis (hypothyroidism) What test would be done in a patient with secondary hypothyroidism to determine whether the cause is hypothalamic or pituitary related? - thyroid-releasing hormone (TRH) test No increase in TSH after injected of TRH suggest a malfunctioning pituitary gland How do you determine doseage of Levothyroxine? - Usual doing 1.6 mcg/kg for adults Anyone 50-60 start on 50 mcg How does Levothyroxine dose differ in the elderly or patients with other comorbidities? - 1.0 mcg/kg for elderly ( This is based on ideal body weight and not actual in an obese patient): Elderly 65 and over: 25 mcg How does Levothryroxine differ from Armour thyroid? - How often does a patient need to be recheck when titrating Levothryroxine dose? - Increase every 3-6 weeks as needed by 12-25mcg until normal TSH What are risks of too much Levothyroxine? - common afib, accelerated bone loss How would you manage a patient with hyperthyroidism? - What lab test done to determine whether or not thyroid medication needs to be raised or lowered - TSH not T4 Know that with subclinical hypothyroidism, treatment is controversial - I would make the decision based on whether or not patient is symptomatic and TSH 10 or greater What is Grave's disease? - Autoimmune process in which antibodies stimulate the TSH receptor leading to overproduction of thyroid hormones How is Grave's disease managed? - Beta blockers Atenolol 25-100 mg daily Propranolol 10-40 mg every 8 hours or extended release 80-160 daily Anti-thyoid medications Methimazole 5-120 mg daily in divided doses Contraindicated in first trimester pregnancy Propylthiouracil 50-300 mg q 8 hours Carries high risk of liver failure, but is drug of choice in 1st trimester of pregnancy Radioactive iodine Contraindicated in severe Graves orbitopathy and pregnant patients What is Addison's disease? - Hypofunction of the adrenal gland which results in inadequate release of glucocorticoids and mineralocorticoids, also called hypoadrenocorticism Primary adrenal insufficiency refers to - when the adrenal gland is damaged and hinders production of hormones May be from autoimmune response, infections, blood loss, or tumors.